| NPI | 1821435868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0969) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: UT 11222370-1204) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2019-04-04 |